Getting MetLife long term disability insurance is an important step many people take in order to protect their income in the event they become disabled. Though consumers rely on their insurance carriers to pay them when the insured becomes disabled, valid claims may be denied.
If you applied for long term disability benefits but were denied, don’t lose hope — a MetLife disability denial isn’t the end of the road. Even after being denied your disability benefits, there are still steps you can take to receive your benefits.
All long term disability (LTD) policies have at least one level of administrative appeal that claimants who have been denied can pursue, and some LTD policies even allow for two levels of administrative appeals. It is not unusual for people to receive their benefits through this appeals process — in fact, it’s quite common.
An experienced lawyer may help boost your chances of successfully appealing a denied MetLife disability claim, or a claim denied by another insurance carrier.
MetLife short term disability insurance is offered in situations where a worker is unable to work for a short period of time. Different insurance companies have different time frames offered in their various short term disability policies; at MetLife, policies range from three months to one year, in which workers can claim a portion of their salary each week.
Short term disability generally provides nearly the worker’s full salary for this period; but of course, this form of coverage only lasts so long.
The difference between short term and long term disability insurance is right there in the name: long term disability insurance is meant to cover longer periods of time with a disability. There are a few extra nuances, however, that are important to take into account.
MetLife long term disability insurance provides monthly, rather than weekly, payments for disability benefits. Payment periods can generally last for periods of six months, two years, five years, ten years, or in some cases even up until the policy holder reaches 65 years of age. Long term disability usually pays a worker an average of 70 percent of the salary they would be receiving at work, though these benefits could be paid out for a much longer period of time.
Not unexpectedly, long term disability insurance costs much more than the short term options. Plus, long term benefits can take several months to kick in, whereas short term benefits can start being paid much more quickly. Fortunately, long term disability benefits are often offered by employers, and workers are not left to pay for these benefits on their own.
In some cases, people choose to purchase both short term and long term disability insurance in order to make sure they’re fully covered in the event of a disabling injury or illness, though this option is considerably more expensive. Many different issues can be factored in to this decision: the individual’s needs and expectations, what their employer provides in their benefit plan, and the cost of the insurance they have available to them.
Insurance companies are for-profit organizations. They make money by taking in premiums and lose money when paying out claims. The fewer claims they accept, the more money insurance companies make.
This means that some insurance companies may deny long-term disability insurance claims, even if the claims may be valid.
An insurance company may cite a number of possible reasons for denying a disability claim. These reasons include, but are not limited to, the following:
These can all be legitimate reasons for a company to deny your claim, but this does not mean that a claim denial is always conclusive. In fact, after having your claim wrongfully denied, there are still options for moving forward and receiving the benefits you’re owed.
If your claim for MetLife long term disability benefits or benefits through another insurer is denied, you have the right to appeal it.
In particular, if your MetLife long term disability insurance plan is provided by your employer, the Employee Retirement Income Security Act (ERISA) gives you certain rights.
ERISA requires insurance providers to accept or deny a claim in a timely manner, and provide reasons why a claim was denied. WikiHow notes that this information should be available in a denial letter provided by the insurance company.
A lawyer can help you put together a strong appeal to maximize your chances of having your claim for MetLife benefits accepted upon appeal.
An acceptance or denial of a disability benefits claim can come down to having the proper documentation in place. An experienced lawyer can help you compile all of the documentation you need to help you demonstrate your eligibility for benefits.
This documentation may include medical records, a statement from your doctor, or information about your occupation. All of this information may be hard to track down, but can be necessary to show that you are indeed disabled. For instance, bringing in relevant medical records that may have been missing the first time or that help establish evidence of the disability can help significantly strengthen your appeal.
Gathering this information is critical in getting your appeal granted. It is also important because if your appeal is denied and you choose to sue your insurance company, a court only considers documentation included in the administrative records. Hiring a lawyer can help you “stack your administrative record,” which can be useful both for your appeal and if your appeal is denied.
Understandably, facing the appeals process can seem bleak since you are appealing to the same company that issued your benefits denial the first time. However, an appeal never goes to the same person who issued the first denial, but instead will be evaluated by an entirely different claim unit. The second claim unit may very well disagree with the initial decision, especially if new evidence has been included to strengthen the claim upon appeal.
Federal law requires that all administrative appeals first be exhausted in an LTD group plan prior to pursuing any litigation. Even with an individual plan, which does not fall under this federal law, exhausting administrative appeals will still provide the opportunity to have your MetLife disability denial overturned without needing to file a lawsuit.
Preparing to appeal a MetLife disability denial, or the denial of any private long-term disability insurance for that matter, involves two major components:
Your denial letter is the most important piece of insight into what your insurance company wants from you. It is required that they state why your claim was denied and provide instructions explaining how to file an appeal. Fully understanding the reason your claim was denied will help you prepare evidence for the appeal. For instance, if your insurance company said your claim was denied because there wasn’t enough medical documentation of your condition, you may consider submitting medical evidence such as X-rays or MRIs.
Your denial letter will also outline how to go about filing an appeal, including important things like deadlines and other requirements. It is important to follow these guidelines to the letter, giving your insurance company no reason to deny your claim. Federal law requires that insurance companies give at least 60 days for a claimant to file an appeal, but some LTD policies allow even more time.
Under ERISA, you have 180 days to appeal the denial of your benefits claim. If you do not file your MetLife disability appeal letter within this window, you lose the right to sue the insurer in federal court if your claim continues to be denied.
Filing an effective MetLife disability appeal letter can be a long process, so using a lawyer in this phase may be key to getting an effective appeal filed within the deadline. Filing promptly, with the help of a lawyer, may be your best shot at getting your MetLife disability claim accepted.
If you are missing out on MetLife benefits, you may be able to file an administrative appeal or two in an attempt to claim the benefits you’re owed.
If you have exhausted all administrative appeals, you can turn to litigation. However, under the Employee Retirement Income Security Act (ERISA), no new evidence can be added to your case for consideration in a lawsuit after the appeals have gone through, so it’s essential that you use your appeal or appeals to add as much favorable evidence to your case as possible.
It may also help to have an experienced attorney at your side to craft your MetLife disability appeal letter, determine what evidence to include, and what experts in the area might be able to help your case — regardless of whether you pursue litigation.
Consulting an attorney can also help you determine if you have a claim, navigate the complexities of litigation, and maximize your potential compensation.
If an insurance company denied your long-term disability insurance claim within the past 180 days, a knowledgeable insurance attorney can help you appeal.
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